K Number
K012730
Device Name
CLEARFIL PORCELAIN BOND ACTIVATOR
Date Cleared
2001-09-13

(30 days)

Product Code
Regulation Number
872.3200
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
CLEAFIL PORCELAIN BOND ACTIVATOR is indicated for the following applications: 1) Repair of porcelain or porcelain fused-to-metal crowns and bridges 1) Restoration of gingival porcelain areas where bonding to porcelain is necessary 3) Increased retention of porcelain inlays, onlays, crowns and veneers 4) Increased retention of composite inlays and onlays
Device Description
This product is contained in CLEARFIL PORCELAIN BOND (K871636) and CLEARFIL VENEER BOND (K900690) which has been submitted to FDA as 510k notifications and permitted to be marketed already.
More Information

No
The 510(k) summary describes a dental bonding agent and does not mention any AI or ML components or functionalities.

No.
The product information indicates its use for bonding and restoration purposes, which are not considered therapeutic interventions where a disease or condition is treated or alleviated.

No
The device is described as a bonding activator used for the repair and retention of dental restorations, not for diagnosing medical conditions.

No

The device description explicitly states it is a "product" contained within other products, implying a physical substance or material, not software.

Based on the provided information, this device is not an IVD (In Vitro Diagnostic).

Here's why:

  • Intended Use: The intended uses listed are all related to dental procedures involving the repair and bonding of porcelain and composite materials in the mouth. These are clinical applications performed directly on a patient, not tests performed on samples taken from a patient in a laboratory setting.
  • Device Description: The description states the product is contained within other dental bonding systems.
  • Lack of IVD Characteristics: There is no mention of analyzing samples (blood, urine, tissue, etc.), detecting diseases or conditions, or providing diagnostic information.

IVD devices are used to examine specimens derived from the human body to provide information for the diagnosis, prevention, or treatment of a disease or condition. This device's function is purely for dental restoration and bonding.

N/A

Intended Use / Indications for Use

The intended uses of this device are as follows:

  1. Repair of porcelain or porcelain fused-to-metal crowns and bridges
  2. Restoration of gingival porcelain areas where bonding to porcelain is necessary
  3. Increased retention of porcelain inlays, onlays, crowns and veneers
  4. Increased retention of composite inlays and onlays

Product codes

KLE

Device Description

Not Found

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Not Found

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Not Found

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K925404

Reference Device(s)

K871636, K900690

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.3200 Resin tooth bonding agent.

(a)
Identification. A resin tooth bonding agent is a device material, such as methylmethacrylate, intended to be painted on the interior of a prepared cavity of a tooth to improve retention of a restoration, such as a filling.(b)
Classification. Class II.

0

SEP 1 3 2001

Image /page/0/Picture/2 description: The image is a black and white logo for Kuraray. The logo features a stylized letter "K" with a geometric design. The word "KURARAY" is printed in a sans-serif font below the letter "K". The logo is simple and modern.

12-39, 1-Chome, Umeda, Kita-ku, Osaka 530-8611, JAPAN : +81-6-348-2603 Facsimile: +81-6-348-2552

KURARAY MEDICAL INC.

K012730

510(k) SUMMARY

1. Submitter

1) NameKURARAY MEDICAL INC.
2) Address1621 Sakazu, Kurashiki, Okayama 710-8622, Japan
3) Contact personKoji Nishida
DENTAL MATERIAL DEPARTMENT
4) DateAugust 9, 2001
5) Contact person in U.S.A.Masaya Sasaki
30th Fl. Metlife Building, 200 Park Avenue, New York,
NY 10166
Telephone : (212)-986-2230
1-(800)-879-1676
Facsimile : (212)-867-3543

2. Name of Device

1) Proprietary NameCLEARFIL PORCELAIN BOND ACTIVATOR
2) Classification NameResin tooth bonding agent (21 CFR 872.3200)
3) Common/Usual NameActivator for bonding systems for restorations

3. Predicate device:

Kuraray Co., Ltd. will transfer the medical device business and the relevant functions including manufacturing facilities to its subsidiary company named Kuraray Medical Inc. on The aim of 510(k) submission is to alter the name and address of October 1st 2001. manufacturer, and not to intend other changes.

The predicate device is as follow.

  • CLEARFIL PORCELAIN BOND ACTIVATOR by Kuraray Co., Ltd. (K925404) 1.

4. Description for the premarket notification

This product is contained in CLEARFIL PORCELAIN BOND (K871636) and CLEARFIL VENEER BOND (K900690) which has been submitted to FDA as 510k notifications and permitted to be marketed already.

1

5. Statement of the intended use

The intended uses of this device are as follows. They are completely the same as CLEARFIL PORCELAIN BOND ACTIVATOR manufactured by Kuraray Co., Ltd. (K925404).

  1. Repair of porcelain or porcelain fused-to-metal crowns and bridges
    1. Restoration of gingival porcelain areas where bonding to porcelain is necessary
    1. Increased retention of porcelain inlays, onlays, crowns and veneers
    1. Increased retention of composite inlays and onlays
    1. Statement of the technological characteristics and safety

This device is essentially the same as CLEARFIL PORCELAIN BOND ACTIVATOR manufactured by Kuraray Co., Ltd. (K925404). Therefore the technological characteristics, chemical ingredients and safety of this device are completely the same as CLEARFIL PORCELAIN BOND ACTIVATOR.

2

Image /page/2/Picture/2 description: The image is a black and white circular logo for the Department of Health & Human Services - USA. The logo features a stylized eagle with three stripes forming its body and wings. The eagle is facing right. Encircling the eagle is the text "DEPARTMENT OF HEALTH & HUMAN SERVICES - USA" in a sans-serif font. The text is arranged to follow the curve of the circle.

SEP 1 3 2001

Food and Drug Administration 9200 Corporate Boulevard Rockville MD 20850

Kuraray Medical Incorporated C/O Ms. Masaya Sasaki Kuraray America, Incorporated 30th Floor Metlife Building 200 Park Avenue New York, New York 10166

Re: K012730

Trade/Device Name: Clearfil Porcelain Bond Activator Regulation Number: 872.3200 Regulation Name: A.ctivator for Bonding Systems for Restorations Regulatory Class: II Product Code: KLE Dated: August 9, 2001 Received: August 14, 2001

Dear Ms. Sasaki:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to such additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements

3

Page 2 - Ms. Sasaki

of the Act or any Federal statutes and regulations administered by other Federal agencies. of the Act of ally I outhal the Act's requirements, including, but not limited to: registration 1 od intilet comply was a 807); labeling (21 CFR Part 801); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if requirements as bet rerair product radiation control provisions (section 531-542 of the Act; 21); CFR 1000-1050.

This letter will allow you to begin marketing your device as described in your 510(k) I mis letter notification. The FDA finding of substantial equivalence of your device to a promative nearleted predicate device results in a classification for your device and thus, permits your device to proceed to the market.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801 If you desire specific as for in vitro diagnostic devices), please contact the Office of Compliance at (301) 594-4613. Additionally, for questions on the promotion and advertising of your device, please contact the Office of Compliance at (301) 594-4639. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR 807.97). Other general information on your responsibilities under the Act may be obtained from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 443-6597 or at its Internet address http://www.fda.gov/cdrh/dsma/dsmamain.html.

Sincerely yours,

Timothy A. Ulatowski

Timo A. Ulatowski Director Division of Dental, Infection Control and General Hospital Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

4

[CLEARFIL PORCELAIN BOND ACTIVATOR, Kuraray Medical Inc.]

K012730

510(k) Number (if known): ____________________________________________________________________________________________________________________________________________________

Device Name: CLEARFIL PORCELAIN BOND ACTIVATOR

Indications for Use

CLEAFIL PORCELAIN BOND ACTIVATOR is indicated for the following applications:

    1. Repair of porcelain or porcelain fused-to-metal crowns and bridges
    1. Restoration of gingival porcelain areas where bonding to porcelain is necessary
    1. Increased retention of porcelain inlays, onlays, crowns and veneers
    1. Increased retention of composite inlays and onlays

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

Prescription Use (Part 21 CFR 801.109) OR

Over-The-Counter Use_

(Optional Format 1-2-96)

Susan Runse

(Division Sign-Off) Division of Dental, Infection Control, and General Hospital 510k) Number _